Social Security disability benefits are designed to provide financial assistance to individuals who are unable to work due to a disabling condition. These benefits can be a crucial lifeline for many, helping cover medical expenses and basic living costs. However, the process of obtaining these benefits can be challenging, and many applicants find themselves facing a denial. Understanding the reasons why you may be denied Social Security disability is the first step in improving your chances of a successful claim. In this article, we’ll explore the most common reasons for denial and what steps you can take if your claim is denied.
Insufficient Medical Evidence
One of the most common reasons Social Security disability claims are denied is the lack of sufficient medical evidence. The Social Security Administration (SSA) requires comprehensive documentation to prove that your condition is severe enough to prevent you from working. This includes detailed medical records, doctor’s notes, test results, and treatment history. Without this evidence, the SSA may not be convinced that your condition meets their definition of disability.
Failure to Follow Prescribed Treatment
Another reason claims are often denied is when an applicant fails to follow prescribed treatment. The SSA expects that you will follow the treatment plan laid out by your healthcare providers, as this demonstrates your commitment to managing your condition. If you do not follow the prescribed treatment without a valid reason, the SSA may conclude that your condition is not as severe as you claim.
Earning Too Much Income
The SSA sets limits on how much income you can earn while still being eligible for disability benefits. This is known as Substantial Gainful Activity (SGA). If your income exceeds the SGA limit, your claim will likely be denied. The SGA limit changes annually, so it’s important to check the current threshold when applying.
Lack of Cooperation
To hopefully avoid having Social Security disability benefits denied, it is important to cooperate with the SSA during the application process. This means attending all scheduled appointments, responding to requests for additional information, and following through with any evaluations required by the SSA. If you fail to cooperate, your claim could be denied due to the lack of necessary information.
Previous Denial of a Disability Claim
Having a previous disability claim denied can negatively impact any future claims you submit. The SSA may view the previous denial as a sign that your condition has not changed or worsened. To overcome a prior denial, you must provide substantial new evidence that was not available during your previous application.
Disability Not Expected to Last 12 Months
To qualify for Social Security disability benefits, your condition must be expected to last at least 12 months or result in death. If your condition is not expected to meet this duration, your claim will likely be denied. This is because the SSA only awards benefits for long-term or terminal disabilities.
Drug or Alcohol Addiction
If drug or alcohol addiction is a material factor in your disability, your claim may be denied. The SSA examines whether your addiction is contributing to your disability and whether you would still be disabled if you stopped using drugs or alcohol. If the answer is no, your claim will likely be denied.
Criminal Conviction
A criminal conviction can also impact your eligibility for Social Security disability benefits. The SSA may deny your claim if your disability arose during the commission of a felony or while you were incarcerated. Additionally, if you are currently imprisoned for a felony conviction, you are generally ineligible to receive benefits during your incarceration. However, once released, you may reapply, provided you meet all other eligibility requirements. It’s important to understand that not all criminal convictions result in denial, but those directly related to your disability or that occur during a period of incarceration can significantly affect your claim.
Failure to Meet Non-Medical Requirements
Aside from medical criteria, there are non-medical requirements that must be met to qualify for Social Security Disability benefits. If you fail to meet these criteria, your claim will be denied regardless of your medical condition. These include:
- Work Credits: Accumulating sufficient work credits through your employment history to qualify for benefits.
- Age Requirements: Meeting specific age-related criteria for eligibility, particularly for those applying for benefits near retirement age.
- Citizenship or Residency Requirements: Being a U.S. citizen or meeting the residency requirements for non-citizens.
Understanding why Social Security denies disability claims can help you take the necessary steps to strengthen your case and increase your chances of securing the benefits you may deserve. If your Social Security denied status has left you feeling uncertain about your next steps, remember a denial is not the end of the road. With the right approach and support, you can successfully appeal and obtain the benefits you need.
Steps to Take After a Social Security Disability Denial
1. Understanding the Denial Letter
The first step after receiving a denial is to carefully read and understand the denial letter. This letter will outline the specific reasons your claim was denied, which will guide your next steps. It’s important to note the deadline for filing an appeal, as missing this deadline could forfeit your right to challenge the decision.
2. Gathering Additional Evidence
If you were denied Social Security disability due to insufficient evidence, gathering additional documentation can strengthen your case for appeal. This may include obtaining more detailed medical records, seeking evaluations from specialists, or getting a second opinion. Working closely with your healthcare providers to help ensure all relevant information is included can make a significant difference.
3. Filing an Appeal
The appeals process includes several stages, starting with a request for reconsideration and potentially leading to a hearing before an administrative law judge. It’s important to follow all procedures and deadlines closely during this process to help ensure your appeal is considered.
4. Seeking Legal Assistance
The appeals process can be complex and time-consuming. Hiring a Social Security disability attorney can provide you with the legal support you need to improve your chances of a successful appeal. An attorney can help you gather evidence, prepare for hearings, and ensure that all legal requirements are met.
How An Attorney Can Help You Appeal a Denied Claim
Having Social Security denied can be frustrating, but hiring an attorney to assist with your Social Security disability appeal can significantly increase your chances of success. An experienced attorney understands the intricacies of the SSA’s requirements and can help you avoid common pitfalls that lead to denial. They can also represent you during hearings and make a strong case on your behalf. Some benefits of hiring an attorney for your appeal include:
- Legal Knowledge: An attorney well-versed in Social Security disability law can help you navigate complex regulations and present a strong case for appeal.
- Comprehensive Case Review: They will thoroughly review your case, identifying weaknesses and areas where additional evidence is needed.
- Document Preparation: An attorney can assist with gathering and organizing the necessary medical records and documentation to strengthen your appeal.
- Effective Representation: They can represent you during hearings, presenting your case persuasively to the judge.
- Timely Appeals: Attorneys can help ensure that all appeal deadlines are met, preventing your case from being dismissed on procedural grounds.
- Peace of Mind: Having an attorney on your side reduces stress and uncertainty, allowing you to focus on your health and well-being.
If you’ve been denied Social Security disability, don’t hesitate to seek legal assistance. At The Law Offices of Dr. Bill LaTour, our Social Security disability attorney proudly serves those throughout Southern California who are pursuing disability benefits. Contact us today to discuss your case and explore your options for appeal.
